[...THE PREVENTION AND CURE OF MYOPIA AND OTHER ERRORS OF REFRACTION

A Method That Succeeded

You cannot see anything with perfect sight unless you have seen it
before. When the eye looks at an unfamiliar object it always strains
more or less to see that object, and an error of refraction is always
produced. When children look at unfamiliar writing, or figures, on the
blackboard, distant maps, diagrams, or pictures, the retinoscope
always shows that they are myopic, though their vision may be under
other circumstances absolutely normal. The same thing happens when
adults look at unfamiliar distant objects. When the eye regards a
familiar object, however, the affect is quite otherwise. Not only can
it be regarded without strain, but the strain of looking later at
unfamiliar objects is lessened.

This fact furnishes us with a means of overcoming the mental strain to
which children are subjected by the modern educational system. It is
impossible to see anything perfectly when the mind is under a strain,
and if children become able to relax when looking at familiar objects,
they become able, sometimes in an incredibly brief space of time, to
maintain their relaxation when looking at unfamiliar objects.

I discovered this fact while examining the eyes of 1,500 school
children at Grand Forks, N. D., in 1903 [1]. In many cases children
who could not read all of the letters on the Snellen test card at the
first test read them at the second or third test. After a class had
been examined the children who had failed would sometimes ask for a
second test, and then it often happened that they would read the whole
card with perfect vision. So frequent were these occurrences that
there was no escaping the conclusion that in some way the vision was
improved by reading the Snellen test card. In one class I found a boy
who at first appeared to be very myopic, but who, after a little
encouragement, read all the letters on the test card. The teacher
asked me about this boy's vision, because she had found him to be very
nearsighted. When I said that his vision was normal she was
incredulous, and suggested that he might have learned the letters by
heart, or been prompted by another pupil. He was unable to read the
writing or figures on the blackboard, she said, or to see the maps,
charts, and diagrams on the walls, and did not recognize people across
the street. She asked me to test his sight again, which I did, very
carefully, under her supervision, the sources of error which she had
suggested being eliminated. Again the boy read all the letters on the
card. Then the teacher tested his sight. She wrote some words and
figures on the blackboard and asked him to read them. He did so
correctly. Then she wrote additional words and figures, which he read
equally well. Finally she asked him to tell the hour by the clock
twenty-five feet distant, which he did correctly. It was a dramatic
situation, both the teacher and the children being intensely
interested. Three other cases in the class were similar, their vision,
which had previously been very defective for distant objects, becoming
normal in the few moments devoted to testing their eyes. It is not
surprising that after such a demonstration the teacher asked to have a
Snellen test card placed permanently in the room. The children were
directed to read the smallest letters they could see from their seats
at least once every day, with both eyes together and with each eye
separately, the other being covered with the palm of the hand in such
a way as to avoid pressure on the eyeball. Those whose vision was
defective were encouraged to read it more frequently, and in fact
needed no encouragement to do so after they found that the practice
helped them to see the blackboard, and stopped the headaches, or other
discomfort, previously resulting from the use of their eyes.

In another class of forty children, between six and eight, thirty of
the pupils gained normal vision while their eyes were being tested.
The remainder were cured later under the supervision of the teacher by
exercises in distant vision with the Snellen card. This teacher had
noted every year for fifteen years that at the opening of the school
in the fall all the children could see the writing on the blackboard
from their seats, but before school closed the following spring all of
them without exception complained that they could not see it at a
distance of more than ten feet. After learning of the benefits to be
derived from the daily practice of distant vision with familiar
objects as the points of fixation, this teacher kept a Snellen test
card continually in her classroom and directed the children to read it
every day. The result was that for eight years no more of the children
under her care acquired defective eyesight.

This teacher had attributed the invariable deterioration in the
eyesight of her charges during the school year to the fact that her
classroom was in the basement and the light poor. But teachers with
well-lighted classrooms had the same experience, and after the Snellen
test card was introduced into both the well-lighted and the poorly
lighted rooms, and the children read it every day, the deterioration
of their eyesight not only ceased, but the vision of all improved.
Vision which had been below normal improved, in most cases, to normal,
while children who already had normal sight, usually reckoned at
20/20, became able to read 20/15 or 20/10. And not only was myopia
cured, but the vision for near objects was improved.

At the request of the superintendent of the schools of Grand Forks,
Mr. J. Nelson Kelly, the system was introduced into all the schools of
the city and was used continuously for eight years, during which time
it reduced myopia among the children, which I found at the beginning
to be about six per cent, to less than one per cent.

In 1911 and 1912 the same system was introduced into some of the
schools of New York City [2], with an attendance of about ten thousand
children. Many of the teachers neglected to use the cards, being
unable to believe that such a simple method, and one so entirely at
variance with previous teaching on the subject, could accomplish the
desired results. Others kept the cards in a closet except when they
were needed for the daily eye drill, lest the children should memorize
them. Thus they not only put an unnecessary burden upon themselves,
but did what they could to defeat the purpose of the system, which is
to give the children daily exercise in distant vision with a familiar
object as the point of fixation. A considerable number, however, used
the system intelligently and persistently, and in less than a year
were able to present reports showing that of three thousand children
with imperfect sight over one thousand had obtained normal vision by
its means. Some of these children, as in the case of the children of
Grand Forks, were cured in a few minutes. Many of the teachers were
also cured, some of them very quickly. In some cases the results of
the system were so astonishing as to be scarcely credible.

In a class of mental defectives, where the teacher had kept records of
the eyesight of the children for several years, it had been invariably
found that their vision grew steadily worse as the term advanced. As
soon as the Snellen test card had been introduced, however, they began
to improve. Then came a doctor from the Board of Health who tested the
eyes of the children and put glasses on all of them, even those whose
sight was fairly good. The use of the card was then discontinued, as
the teacher did not consider it proper to interfere while the children
were wearing glasses prescribed by a physician. Very soon, however,
the children began to lose, break, or discard, their glasses. Some
said that the spectacles gave them headaches, or that they felt better
without them. In the course of a month or so most of the aids to
vision which the Board of Health had supplied had disappeared. The
teacher then felt herself at liberty to resume the use of the Snellen
test card. Its benefits were immediate. The eyesight and the mentality
of the children improved simultaneously, and soon they were all
drafted into the regular classes, because it was found that they were
making the same progress in their studies as the other children were.

Another teacher reported an equally interesting experience. She had a
class of children who did not fit into the other grades. Many of them
were backward in their studies. Some were persistent truants. All of
them had defective eyesight. A Snellen test card was hung in the
classroom where all the children could see it, and the teacher carried
out my instructions literally. At the end of six months all but two
had been cured and these had improved very much, while the worst
incorrigible and the worst truant had become good students. The
incorrigible, who had previously refused to study, because, he said,
it gave him a headache to look at a book, or at the blackboard, found
out that the test card, in some way, did him a lot of good; and
although the teacher had asked him to read it but once a day, he read
it whenever he felt uncomfortable. The result was that in a few weeks
his vision had become normal and his objection to study had
disappeared. The truant had been in the habit of remaining away from
school two or three days every week, and neither his parents nor the
truant officer had been able to do anything about it. To the great
surprise of his teacher he never missed a day after having begun to
read the Snellen test card. When she asked for an explanation he told
her that what had driven him away from school was the pain that came
in his eyes whenever he tried to study, or to read the writing on the
blackboard. After reading the Snellen test card, he said, his eyes and
head were rested and he was able to read without any discomfort.

To remove any doubts that might arise as to the cause of the
improvement noted in the eyesight of the children comparative tests
were made with and without cards. In one case six pupils with
defective sight were examined daily for one week without the use of
the test card. No improvement took place. The card was then restored
to its place and the group was instructed to read it every day. At the
end of a week all had improved and five were cured. In the case of
another group of defectives the results were similar. During the week
that the card was not used no improvement was noted, but after a week
of exercises in distant vision with the card all showed marked
improvement, and at the end of a month all were cured. In order that
there might be no question as to the reliability of the records of the
teachers some of the principals asked the Board of Health to send an
inspector to test the vision of the pupils, and whenever this was done
the records were found to be correct.

One day I visited the city of Rochester, and while there I called on
the Superintendent of Public Schools and told him about my method of
preventing myopia. He was very much interested and invited me to
introduce it in one of his schools. I did so, and at the end of three
months a report was sent to me showing that the vision of all the
children had improved, while quite a number of them had obtained
perfect sight in both eyes.

The method has been used in a number of other cities and always with
the same result. The vision of all the children improved, and many of
them obtained perfect sight in the course of a few minutes, days,
weeks or months.

It is difficult to prove a negative proposition, but since this system
improved the vision of all the children who used it, it follows that
none could have grown worse. It is therefore obvious that it must have
prevented myopia. This cannot be said of any method of preventing
myopia in schools which had previously been tried. All other methods
are based on the idea that it is the excessive use of the eyes for
near work that causes myopia, and all of them have admittedly failed.

It is also obvious that the method must have prevented other errors of
refraction, a problem which previously had not even been seriously
considered, because hypermetropia is supposed to be congenital, and
astigmatism was until recently supposed also to be congenital in the
great majority of cases. Anyone who knows how to use a retinoscope
may, however, demonstrate in a few minutes that both of these
conditions are acquired; for no matter how astigmatic or hypermetropic
an eye may be, its vision always becomes normal when it looks at a
blank surface without trying to see. It may also be demonstrated that
when children are learning to read, write, draw, sew, or to do
anything else that necessitates their looking at unfamiliar objects at
the near-point, hypermetropia, or hypermetropic astigmatism, is always
produced. The same is true of adults. These facts have not been
reported before, so far as I am aware, and they strongly suggest that
children need, first of all, eye education. They must be able to look
at strange letters or objects at the near-point without strain before
they can make much progress in their studies, and in every case in
which the method has been tried it has proven that this end is
attained by daily exercise in distant vision with the Snellen test
card. When their distant vision has been improved by this means
children invariably become able to use their eyes without strain at
the nearpoint.

The method succeeded best when the teacher did not wear glasses. In
fact, the effect upon the children of a teacher who wears glasses is
so detrimental that no such person should be allowed to be a teacher,
and since errors of refraction are curable, such a ruling would work
no hardship on anyone. Not only do children imitate the visual habits
of a teacher who wears glasses, but the nervous strain of which the
defective sight is an expression produces in them a similar condition.
In classes of the same grade, with the same lighting, the sight of
children whose teachers did not wear glasses has always been found to
be better than the sight of children whose teachers did wear them. In
one case I tested the sight of children whose teacher wore glasses and
found it very imperfect. The teacher went out of the room on an
errand, and after she had gone I tested them again. The results were
very much better. When the teacher returned she asked about the sight
of a particular boy, a very nervous child, and as I was proceeding to
test him she stood before him and said, "Now, when the doctor tells
you to read the card, do it." The boy couldn't see anything. Then she
went behind him, and the effect was the same as if she had left the
room. The boy read the whole card.

Still better results would be obtained if we could reorganize the
educational system on a rational basis. Then we might expect a general
return of that primitive acuity of vision which we marvel at so
greatly when we read about it in the memoirs of travellers. But even
under existing conditions it has been proven beyond the shadow of a
doubt that errors of refraction are no necessary part of the price we
must pay for education.

There are at least ten million children in the schools of the United
States who have defective sight. This condition prevents them from
taking full advantage of the educational opportunities which the State
provides. It undermines their health and wastes the taxpayers' money.
If allowed to continue, it will be an expense and a handicap to them
throughout their lives. In many cases it will be a source of continual
misery and suffering. And yet practically all of these cases could be
cured and the development of new ones prevented by the daily reading
of the Snellen test card.

Why should our children be compelled to suffer and wear glasses for
want of this simple measure of relief ? It costs practically nothing.
In fact, it would not be necessary, in some cases, as in the schools
of New York City, even to purchase the Snellen test cards, as they are
already being used to test the eyes of the children. Not only does It
place practically no additional burden upon the teachers, but, by
improving the eyesight, health, disposition and mentality of their
pupils, it greatly lightens their labors. No one would venture to
suggest, further, that it could possibly do any harm. Why, then,
should there be any delay about Introducing it into the schools? If
there is still thought to be need for further investigation and
discussion, we can investigate and discuss just as well after the
children get the cards as before, and by adopting that course we will
not run the risk of needlessly condemning another generation to that
curse which heretofore has always dogged the footsteps of
civilization, namely, defective eyesight. I appeal to all who read
these lines to use whatever influence they possess toward the
attainment of this end.

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[1] Bates: The Prevention of Myopia in School Children, N. Y. Med.
Jour., July 29, 1911
[2] Bates: Myopia Prevention by Teachers, N. Y. Med. Jour., Aug. 30,
1913...]

- Dr. W.H. Bates, August 1919